Outcome of undisplaced and moderately displaced femoral neck fractures

BACKGROUND: The optimal treatment for femoral neck fracture is a matter of controversy. We compared the outcome of displaced fractures with good healing potential (moderately displaced fractures) to the outcome of undisplaced fractures treated by internal fixation with 2 parallel screws. METHODS: In a consecutive series of hip fracture patients, the rates of reoperation and mortality for 225 undisplaced fractures were compared to those for 241 moderately displaced fractures. The patients were followed for 1-6 years. RESULTS: The total rate of reoperation was 19% (9% because of healing complications) for the undisplaced fractures and 33% (20% because of healing complications) for the moderately displaced fractures. Fracture displacement was the main predictor of reoperation. There was no difference in mortality between the groups, and patient-related background parameters (rather than fracture displacement) were the main predictors of mortality. INTERPRETATION: Undisplaced fractures should be treated by internal fixation. The best treatment for moderately displaced fractures remains to be determined.